[Assessment of paclitaxel treatment of non-small-cell lung cancer]

[Pharmacoeconomic assessment of taxanes as first-line therapy for advanced or metastatic non-microcytic lung cancer]

OBJECTIVE

The goal of this study was to determine the effectiveness of taxane-containing regimens versus non-taxane-containing regimens using a metanalysis and its subsequent pharmacoeconomic assessment to define the role of taxanes as first-line therapy for non micro-cytic lung cancer.

METHOD

A search of the MEDLINE database from 2000 to June 2005 was performed. The search was restricted to phase-III clinical trials, and 29 papers were selected. Effectivity measures considered included: objective response, 1- and 2-year survival. Maentel-Haenszel combined odds ratio (OR) was estimated in the metanalysis. The statistical analysis of effectiveness across categories was performed using a one-way analysis of variance (ANOVA). Differences were statistically considered for p values = 0.01. All results obtained were weighted according to number of patients.

RESULTS

OR estimates for the various effectiveness variables showed statistically significant differences when 2-year survival was considered both for taxanes in general and docetaxel specifically versus non-taxane regimens. These same results are seen when the effectiveness analysis is performed using ANOVA. For the pharmacoeconomic analysis taxane-free regimens were considered as reference, this being of choice for comparisons versus paclitaxel-containing regimens whereas the selection of docetaxel-containing schemes represents additional costs per extra effectiveness unit that oscillate between 26,559 and 96,527 (2-year survival and objective response, respectively) versus taxane-free regimens. The sensitivity analysis ultimately confirmed our study s results.

CONCLUSIONS

To conclude, taxane-containing schemes are valid therapeutic options, but at a very high cost.

[Docetaxel in combination with cisplatin for first-line treatment of locally advanced or metastatic non-small cell lung cancer: meta-analysis of randomized and controlled clinical trials]

BACKGROUND AND OBJECTIVE

Recent approval of docetaxel in combination with cisplatin (DP) for non-small cell lung cancer (NSCLC) treatment means that an assessment of its effectiveness and toxicity is necessary. The aim of this study was to evaluate docetaxel/cisplatin combination versus other cisplatin-based regimens as the front-line treatment of metastatic or locally advanced NSCLC.

MATERIAL AND METHOD

We searched randomized and controlled phase III clinical trials comparing DP versus other cisplatin combinations. Patients had to be diagnosed of advanced NSCLC and had not previously received chemotherapy.A meta-analysis was performed using the Mantel-Haenzel method. Antitumoral activity and adverse events were both evaluated. We also made a heterogeneity test and determined the NNT Index (Number Needed to Treat) for two-year survival.

RESULTS

We found three clinical trials that fulfilled our criteria. Results showed significant enhanced two-year survival for DP (11-47% higher than others), but a greater incidence of diarrhea (odds ratio [OR] = 2.525; confidence interval 95% [CI], 1.697-3.756]). Heterogeneity was significant for response, anemia and thrombopenia. NNT was 17 patients for two-year survival.

CONCLUSIONS

DP is a good option in first-line therapy of advanced NSCLC. The two-year survival is significantly longer and its toxic profile similar to other treatments, except for diarrhea.